title: Active tuberculosis among homeless persons, Toronto, Ontario, Canada, 1998-2007.
abstract: While tuberculosis (TB) in Canadian cities is increasingly affecting foreign-born persons, homeless persons remain at high risk. To assess trends in TB, we studied all homeless persons in Toronto who had a diagnosis of active TB during 1998-2007. We compared Canada-born and foreign-born homeless persons and assessed changes over time. We identified 91 homeless persons with active TB; they typically had highly contagious, advanced disease, and 19% died within 12 months of diagnosis. The proportion of homeless persons who were foreign-born increased from 24% in 1998-2002 to 39% in 2003-2007. Among foreign-born homeless persons with TB, 56% of infections were caused by strains not known to circulate among homeless persons in Toronto. Only 2% of infections were resistant to first-line TB medications. The rise in foreign-born homeless persons with TB strains likely acquired overseas suggests that the risk for drug-resistant strains entering the homeless shelter system may be escalating.
authors.affiliation: St. Michael's Hospital, Toronto, Ontario, Canada. khank@smh.ca
authors.forename: Kamran
authors.initials: K
authors.lastname: Khan
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Rea
authors.forename: Cameron
authors.initials: C
authors.lastname: McDermaid
authors.forename: Rebecca
authors.initials: R
authors.lastname: Stuart
authors.forename: Catharine
authors.initials: C
authors.lastname: Chambers
authors.forename: Jun
authors.initials: J
authors.lastname: Wang
authors.forename: Angie
authors.initials: A
authors.lastname: Chan
authors.forename: Michael
authors.initials: M
authors.lastname: Gardam
authors.forename: Frances
authors.initials: F
authors.lastname: Jamieson
authors.forename: Jae
authors.initials: J
authors.lastname: Yang
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Hwang
mesh_terms: D000328:Adult; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data; D005260:Female; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D012307:Risk Factors; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality